Multicentre prospective study of drug-eluting bead chemoembolisation safety using tightly calibrated small microspheres in non-resectable hepatocellular carcinoma.

PURPOSE: To assess the safety and tolerability of transarterial drug-eluting bead chemoembolisation (DEB-TACE) using tightly calibrated 100-µm microspheres in hepatocellular carcinoma (HCC). METHOD: This multicentre prospective study included 131 patients with a 2-year follow-up. All patients had Child-Pugh scores ≤ B7, a good performance status, and Barcelona Clinic Liver Cancer stage A or B. Beads were loaded with 50 mg of doxorubicin per millilitre. Overall, 223 nodules were treated (mean size: 27.6 mm, average number of nodules per patient: 1.7). Toxicity was assessed using Common Terminology Criteria for Adverse Events 4.03 and response according to the modified Response Evaluation Criteria in Solid Tumours. The primary endpoint was safety. Secondary endpoints included technical success, post-embolisation syndrome (PES), local tumour response, and 2-year survival. RESULTS: A total of 214 DEB-TACE procedures were performed (mean per patient: 1.64), with a technical success rate of 97.6 % and a PES rate of 9.3 %. Major complications occurred in 6.8 % of patients and 4.1 % of procedures. There were no treatment-related deaths. Doxorubicin dose was an independent predictor of complications (p = 0.01). Four patients were lost to follow-up and 18 received liver transplants. Objective response rates were 74.6 %, 45.7 %, and 44.1 % at 6, 12, and 24 months, respectively. The cumulative 24-month overall survival rate was 55.96 %. Median survival was 22 months (interquartile range = 13-24). Co-morbidities and tumour response were independent predictors of survival (p = 0.0012 and 0.0052, respectively). Complications did not affect survival (p = 0.24). CONCLUSIONS: DEB-TACE with tightly calibrated 100-µm beads is safe and not associated with increases in biliary toxicity or complications. Tumour response and survival are in the expected range for chemoembolisation therapy. (Clinical trials ID: NCT02670122).

[Magnetic resonance imaging and spectrometric study of the distribution of thermotherapeutic magnetofluid after intra-arterial administration in an experimental model of liver metastases]. / Administración intrarterial de un magnetofluido termoterapéutico en un modelo experimental de metástasis hepáticas. Estudio de distribución con resonancia magnética y espectrometría.

OBJECTIVE: To use imaging and laboratory techniques to evaluate the vascular distribution of magnetofluid in a rat model of liver metastases. MATERIAL AND METHODS: The livers of 33 WAG/Rij Crl rats were seeded with CC-531 colorectal cancer cells. After we checked tumor development, 10 rats received hepatic intra-arterial infusions of Lipiodol(®) with nanoparticles of Fe(3)O(4) in suspension, and 5 were reserved as controls. Axial STIR (TR: 3,600 ms/TE: 29 ms/TI: 130 ms) and gradient-echo (GE) (120/4 and 120/14) MRI sequences were acquired on a 1.5 T scanner. After necropsy, rats were classified into one of two stages according to tumor development: early (<10 metastases, each < 3mm) or advanced (>10 metastases, each >3 mm). Samples of liver and of metastases were taken from the 15 animals for quantification of iron concentrations by inductively coupled plasma mass spectrometry (ICP-MS). The data were analyzed using nonparametric tests; values of p < 0.05 were considered significant. RESULTS: Five animals had early tumor development and five had advanced tumor development. In the GE sequences, early stage metastases showed homogeneous signal reduction attributable to the presence of magnetofluid. Spectrometry found significant differences between the iron concentration in rats with early stage metastases and controls (p=0.002) as well as between rats with early stage metastases and those with late stage metastases (p=0.001). The ratio of exogenous iron in metastases and in liver in early stage rats was 2.6:1. The concentration of exogenous iron in the liver was significantly different from that in tumors only in early stage animals (p=0.043). CONCLUSIONS: MRI and spectrometry made it possible to evaluate the vascular distribution of magnetofluid in the liver and revealed the differences in its affinity for metastases in different stages of disease.

High-frequency ultrasound imaging for longitudinal evaluation of non-alcoholic fatty liver disease progression in mice.

Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of hepatic damage in developed countries. For this reason, mouse models of NAFLD have been developed to show progression of the disease because it perfectly resembles the human pathology. Here we show that diagnostic high-frequency ultrasound imaging (US) may be used as an effective method for monitoring the progression of liver disease, from steatosis to hepatocellular carcinoma in the methionine adenosyl transferase and glycine N-methyltransferase-deficient mice models. US reliably detected murine liver lesions associated with NAFLD in the two mice strains tested, with excellent agreement among US images, gross pathology and histological sections. Our results suggest US as a relevant approach for the study of NAFLD in mice, with interesting technical and therapeutic implications.

[Ultrasonographic characterization of an experimental model of liver metastases from colon carcinoma in rats]. / Caracterización ecográfica de un modelo experimental de metástasis hepáticas de carcinoma de colon.

OBJECTIVE: To determine the ultrasonographic characteristics of liver metastases induced in a rat model; to evaluate the usefulness of ultrasonography in the noninvasive evaluation of tumor infiltration. MATERIAL AND METHODS: We seeded the livers of 46 WAG/RijCrl rats with CC-531 syngeneic colorectal carcinoma cells by intrasplenic inoculation. At 21, 28, 35, 42, 70 days after tumor seeding, we performed a series of ultrasonographic examinations to evaluate tumor induction in different groups of animals: 37 rats were studied with a 10 MHz linear probe and 9 were studied with a 6-18 MHz multifrequency probe. The following signs were considered indicative of tumor development: intrahepatic nodules, sinuate liver borders, lobe enlargement, and extrahepatic masses. Ultrasonographic findings were verified at autopsy. We determined the number of implants, size (less than 3mm, between 3 and 7 mm, or greater than 7 mm), and lobe location for each technique. RESULTS: Compared to the autopsy results, ultrasonography detected 64% of the animals with disease. All the extrahepatic masses were correctly diagnosed. Metastases were identified in 90% of the rats with lesions greater than 7 mm, in 75% of those with implants between 3 and 7 mm, and in 25% of those with lesions less than 3mm. In the group in which we used the 6-18 MHz probe, we detected 50% of the lesions less than 3mm. CONCLUSION: Ultrasonography was useful for monitoring the experimental model and enabled the noninvasive oncologic evaluation of the rat liver with reasonable sensitivity.

[Diagnosis and quantification of iron overload in the liver using MRI]. / Diagnóstico y cuantificación de la sobrecarga férrica en el hígado mediante resonancia magnética.

Hereditary hemochromatosis is the most common cause of iron overload. The diagnosis of hereditary hemochromatosis has improved since Feder et al. isolated the HFE gene in 1996 and discovered the mutations related with this disease. Nevertheless, in many cases genetic tests for hereditary hemochromatosis are negative. These cases require diagnostic confirmation by quantifying the concentration of iron in the liver (LIC); this has traditionally been accomplished by liver biopsy. Many studies have shown that it is possible to quantify LIC using MRI. However, a consensus has yet to be reached about the most appropriate technique or whether it is possible to reproduce the same methods of calculation on different MRI units. This article reviews the current state of these questions and points to possible lines to standardize this noninvasive method of quantifying LIC in the future.

Soluciones endovasculares ante aneurismas ilíacos anatómicamente complejos / Endovascular solutions when dealing with anatomically complex iliac aneurysms

Introducción. El tratamiento endovascular de aneurismas aortoilíacos es hoy un procedimiento rutinario. Pero,a pesar de grandes avances en el diseño y el tratamiento de los dispositivos, limitaciones anatómicas todavía impidensu utilización en muchos pacientes. En otros casos constituyen un desafío técnico potencialmente solucionable. Casoclínico. Varón de 70 años con antecedentes de injerto aortoaórtico por aneurisma de aorta abdominal infrarrenal seisaños antes, desarrolla un crecimiento progresivo de sus arterias ilíacas comunes hasta 36 y 40 mm de diámetro. Presentatambién un aneurisma hipogástrico izquierdo (30 mm) y aneurisma de arteria femoral común derecha (26 mm). Proximalal injerto aortoaórtico, nace una arteria polar inferior derecha. Los orígenes de ambas ilíacas comunes son estenóticos(10 y 8 mm) y ambas bifurcaciones ilíacas se encuentran dilatadas. Realizamos: dilatación transluminal del origende la arteria ilíaca común izquierda, embolización del aneurisma hipogástrico izquierdo, implante de una endoprótesisaortomonoilíaca izquierda con anclaje proximal en el injerto aortoaórtico previo (preservando la arteria polar) yextensión a arteria ilíaca externa, injerto femorofemoral ipsilateral corto sustituyendo el aneurisma femoral derecho,implante de stent recubierto desde la arteria ilíaca externa hasta la hipogástrica derechas para preservar el flujo pélvicodirecto e injerto femorofemoral izquierda-derecha. Se consigue el sellado completo de los aneurismas y una adecuadaperfusión de la arteria hipogástrica derecha, con buena evolución del paciente. Conclusión. La anatomía complejade este caso requería un diseño imaginativo e individualizado del procedimiento. El desarrollo tecnológico ofrece cadavez más posibilidades de tratamiento endovascular en aneurismas aortoilíacos progresivamente más complejos

Introduction. Endovascular treatment of aortoiliac aneurysms is nowadays a rutinary procedure. However,despite great advances in the design and management of the devices, anatomic limitations still preclude its use in manypatients. In other cases these limitations become technical challenges which can potentially be solved. Case report.Male, 70-years-old, surgical history of aortoaortic bypass for the treatment of an infrarenal abdominal aortic aneurysmsix years previously, develops progressive growth of common iliac arteries up to 36 and 40 mm diameter. The studyreveals a left hypogastric aneurysm (30 mm) and a right common femoral aneurysm (26 mm). A right inferior accessoryrenal artery arises proximal to the aortic graft. The origin of both common iliac arteries is stenotic (10 and 8 mm) andboth iliac bifurcations are dilated. We performed: transluminal angioplasty of the origin of the left common iliac artery,embolization of the left hypogastric aneurysm, implant of a left aortoiliac endoprosthesis with proximal seal on theprevious aortic graft (preserving the accesory renal artery) and distal extension to the external iliac artery, ipsilateralshort femorofemoral bypass substituting the right femoral aneurysm, implant of a stent-graft from the right external iliacartery to the ipsilateral hypogastric artery in order to preserve direct pelvic flow, and left-right femoro-femoral bypass.We achieved complete exclusion of the aneurysms and adequate right hypogastric perfusion, with good recovery of thepatient. Conclusion. The complex anatomy of this case required an imaginative and individualized design of theprocedure. Technological development offers increasing possibilities for the endovascular treatment of increasinglycomplex aortoiliac aneurysms

Diagnóstico y cuantificación de la sobrecarga férrica en el hígado mediante resonancia magnética / Diagnosis and quantification of iron overload in the liver using MRI

La hemocromatosis hereditaria es la modalidad más frecuente de sobrecarga férrica. El diagnóstico de la misma ha mejorado desde que en 1996 Feder et al aislaron el gen HFE descubriendo las mutaciones relacionadas con la enfermedad. Sin embargo, son muchos los pacientes con estudios genéticos negativos, y que por tanto requieren una confirmación diagnóstica mediante la cuantificación de la concentración de hierro en hígado (CHH) que tradicionalmente se ha realizado mediante biopsia hepática. Muchos estudios han demostrado la posibilidad de cuantificar la CHH mediante resonancia magnética. Sin embargo, todavía no existe un consenso en cuanto a la técnica más idónea ni en cuanto a la posibilidad o no de reproducir el mismo método de cálculo en diferentes máquinas. Este artículo revisa la realidad de estas cuestiones y señala posibles líneas de futuro para estandarizar este método no invasivo de cuantificación de la CHH

Hereditary hemochromatosis is the most common cause of iron overload. The diagnosis of hereditary hemochromatosis has improved since Feder et al. isolated the HFE gene in 1996 and discovered the mutations related with this disease. Nevertheless, in many cases genetic tests for hereditary hemochromatosis are negative. These cases require diagnostic confirmation by quantifying the concentration of iron in the liver (LIC); this has traditionally been accomplished by liver biopsy. Many studies have shown that it is possible to quantify LIC using MRI. However, a consensus has yet to be reached about the most appropriate technique or whether it is possible to reproduce the same methods of calculation on different MRI units. This article reviews the current state of these questions and points to possible lines to standardize this noninvasive method of quantifying LIC in the future

[Obstructive uropathy secondary to genitourinary prolapse]. / Uropatía obstructiva secundaria a prolapso genitourinario.

Genital prolapse is associated to a greater concurrence of repeat urinary infections, stress urinary incontinence, arterial hypertension and obstructive uropathy with a higher or lower degree of renal impairment. Incidence of uropathy in the genital prolapse setting ranges between 4 and 13%. This paper presents a female patient with renal insufficiency secondary to bilateral obstructive uropathy caused by a concomitant genital prolapse. A brief revision is made of the pathophysiological, diagnostic and therapeutic aspects in the literature. The need to perform both prone and standing urographic studies is emphasized; also a study of the renal function should be performed in these patients in order to establish the appropriate treatment and avoid major complications and renal function impairment.